You & Your Hormones | Hormones | Prolactin You & Your Hormones Email article to a friend | Last updated: March 31, 2015 Prolactin is a hormone produced in the pituitary gland, named because of its role in lactation. It also has other wide ranging functions in the body from acting on the reproductive system to influencing behaviour and regulating the immune system. Alternative names for prolactin In everyday language, prolactin is referred to as the ‘milk hormone’; PRL; luteotropic hormone; LTH. What is prolactin? Prolactin is a hormone named originally after its function to promote milk production (lactation) in mammals in response to the suckling of young after birth. It has since been shown to have more than 300 functions in the body. These can be divided into a number of areas: reproductive, metabolic, regulation of fluids (osmoregulation), regulation of the immune system (immunoregulation) and behavioural functions. In humans, prolactin is produced both in the front portion of the pituitary gland (anterior pituitary gland) and in a range of sites elsewhere in the body.

Lactotroph cells in the pituitary gland produce prolactin, where it is stored in small containers called vesicles. Prolactin is released into the bloodstream by a process called exocytosis. Human prolactin is also produced in the uterus, immune cells, brain, breasts, prostate, skin and adipose tissue . How is prolactin controlled? One of the main regulators of the production of prolactin from the pituitary gland is the hormone called dopamine, which is produced by the hypothalamus , the part of the brain directly above the pituitary gland. Dopamine restrains prolactin production, so the more dopamine there is, the less prolactin is released. Prolactin itself enhances the secretion of dopamine, so this creates a negative feedback loop. Oestrogen is another key regulator of prolactin and has been shown to increase the production and secretion of prolactin from the pituitary gland. Studies have shown small increases in prolactin in the blood circulation of women during stages of their reproductive cycle where oestrogen levels are at their highest.

This is also the case during and after pregnancy, which makes sense, since a higher level of circulating prolactin is needed to cause lactation to start. In addition to dopamine and oestrogen, a whole range of other hormones can both increase and decrease the amount of prolactin released in the body, with some examples being thyrotropin-releasing hormone , oxytocin and anti-diuretic hormone . What happens if I have too much prolactin? The condition of having too much prolactin circulating in the blood is called hyperprolactinaemia. The most common causes of hyperprolactinaemia include pregnancy, medications that reduce dopamine action in the body, thyroid underactivity and benign pituitary tumours (known as prolactinomas). Symptoms can include the unwanted production of milk, disturbances to the menstrual cycle and symptoms due to oestrogen deficiency (in women) or testosterone deficiency (in men). The vast majority of patients with a prolactinoma can be treated successfully using drugs which mimic the action of dopamine. The most commonly used is cabergoline. What happens if I have too little prolactin?

The condition of having too little prolactin circulating in the blood is called hypoprolactinaemia. This condition is very rare and may occur in people with pituitary underactivity. A decrease in the amount of prolactin secreted can lead to insufficient milk being produced after giving birth. Most people with low prolactin levels do not have any specific medical problems, although preliminary evidence suggests they might have reduced immune responses to some infections. Prolactin Glossary Prolactin Prolactin is a single-chain protein hormone closely related to growth hormone. It is secreted by so-called lactotrophs in the anterior pituitary. It is also synthesized and secreted by a broad range of other cells in the body, most prominently various immune cells, the brain and the decidua of the pregnant uterus. Prolactin is synthesized as a prohormone. Following cleavage of the signal peptide, the length of the mature hormone is between 194 and 199 amino acids, depending on species. Hormone structure is stabilized by three intramolecular disulfide bonds.

Physiologic Effects of Prolactin The conventional view of prolactin is that its major target organ is the mammary gland, and stimulating mammary gland development and milk production pretty well define its functions. Such a picture is true as far as goes, but it fails to convey an accurate depiction of this multifunctional hormone. It is difficult to point to a tissue that does not express prolactin receptors, and although the anterior pituitary is the major source of prolactin, the hormone is synthesized and secreted in many other tissues. Overall, several hundred different actions have been reported for prolactin in various species. Some of its major effects are summarized here. Mammary Gland Development, Milk Production and Reproduction In the 1920's it was found that extracts of the pituitary gland, when injected into virgin rabbits, induced milk production. Subsequent research demonstrated that prolactin has two major roles in milk production: Prolactin induces lobuloalveolar growth of the mammary gland. Alveoli are the clusters of cells in the mammary gland that actually secrete milk. Prolactin stimulates lactogenesis or milk production after giving birth.

Prolactin, along with cortisol and insulin, act together to stimulate transcription of the genes that encode milk proteins. The critical role of prolactin in lactation has been confirmed in mice with targeted deletions in the prolactin gene. Female mice that are heterozygous for the deleted prolactin gene (and produce roughly half the normal amount of prolactin) show failure to lactate after their first pregnancy. Prolactin also appears important in several non-lactational aspects of reproduction. In some species (rodents, dogs, skunks), prolactin is necessary for maintainance of corpora lutea (ovarian structures that secrete progesterone, the "hormone of pregnancy"). Mice that are homozygous for an inactivated prolactin gene and thus incapable of secreting prolactin are infertile due to defects in ovulation, fertilization, preimplantation development and implantation. Finally, prolactin appears to have stimulatory effects in some species on reproductive or maternal behaviors such as nest building and retrieval of scattered young.

Effects on Immune Function The prolactin receptor is widely expressed by immune cells, and some types of lymphocytes synthesize and secrete prolactin. These observations suggest that prolactin may act as an autocrine or paracrine modulator of immune activity. Interestingly, mice with homozygous deletions of the prolactin gene fail to show significant abnormalities in immune responses. A considerable amount of research is in progress to delineate the role of prolactin in normal and pathologic immune responses. It appears that prolactin has a modulatory role in several aspects of immune function, but is not strictly required for these responses. Control of Prolactin Secretion In contrast to what is seen with all the other pituitary hormones, the hypothalamus tonically suppresses prolactin secretion from the pituitary. In other words, there is usually a hypothalamic "brake" set on the lactotroph, and prolactin is secreted only when the brake is released. If the pituitary stalk is cut, prolactin secretion increases, while secretion of all the other pituitary hormones fall dramatically due to loss of hypothalamic releasing hormones.

Dopamine serves as the major prolactin-inhibiting factor or brake on prolactin secretion. Dopamine is secreted into portal blood by hypothalamic neurons, binds to receptors on lactotrophs, and inhibits both the synthesis and secretion of prolactin. Agents and drugs that interfere with dopamine secretion or receptor binding lead to enhanced secretion of prolactin. In addition to tonic inhibition by dopamine, prolactin secretion is positively regulated by several hormones, including thyroid-releasing hormone , gonadotropin-releasing hormone and vasoactive intestinal polypeptide. Stimulation of the nipples and mammary gland, as occurs during nursing, leads to prolactin release. This effect appears to be due to a spinal reflex arc that causes release of prolactin-stimulating hormones from the hypothalamus. Estrogens provide a well-studied positive control over prolactin synthesis and secretion. The increasing blood concentrations of estrogen during late pregnancy appear responsible for the elevated levels of prolactin that are necessary to prepare the mammary gland for lactation at the end of gestation. Disease States Excessive secretion of prolactin - hyperprolactinemia - is a relatively common disorder in humans.

This condition has numerous causes, including prolactin-secreting tumors and therapy with certain drugs. Common manifestations of hyperprolactinemia in women include amenorrhea (lack of menstrural cycles) and galactorrhea (excessive or spontaneous secretion of milk). Men with hyperprolactinemia typically show hypogonadism, with decreased sex drive, decreased sperm production and impotence. Such men also often show breast enlargement (gynecomastia), but very rarely produce milk. Hyperprolactinemia Symptoms and Treatment | Hormone Health Network Janet Schlechte, MD Hyperprolactinemia Diagnosis and Treatment Hyperprolactinemia is the name for higher-than-normal blood levels of the hormone prolactin. This hormone is made by the pituitary gland, which is located at the base of the brain. The main function of prolactin is to stimulate breast milk production after childbirth. High prolactin levels are normal during pregnancy and breastfeeding. In other cases, prolactin can become too high because of a disease or the use of certain medications. Often, the cause is a prolactin-making tumor on the pituitary gland, called a prolactinoma.

This tumor is almost always benign, meaning not cancerous. It is more common in women than men. Rarely, children and adolescents develop prolactinomas. Other brain tumors may also cause the pituitary gland to make too much prolactin. Prolactin lowers levels of sex hormones (estrogen and testosterone) in both men and women. Too much prolactin and the resulting drop in estrogen or testosterone can lead to sexual and menstrual dysfunction. This guide for patients is based on The Endocrine Society’s practice guidelines for physicians about the diagnosis and treatment of hyperprolactinemia. What are the effects of hyperprolactinemia? Both men and women with high prolactin levels may have infertility, low sex drive, and bone loss. Also, women may have: No menstrual periods or irregular periods Vaginal dryness, making sex painful Breast discharge when not pregnant or nursing Adolescent girls may also have menstrual problems and breast discharge. Men may have: Erectile dysfunction—trouble getting or keeping an erection Decreased body hair and muscle mass Boys may have delayed puberty and low testosterone levels. Someone with a large prolactinoma may have headaches and/or vision problems.

This is because the optic nerve, which is needed for sight, is near the pituitary gland and may be injured by a large tumor. Some people with hyperprolactinemia have no symptoms. How is this condition diagnosed? Doctors detect excess prolactin with a blood test that measures the prolactin level. Most often, a single blood test is all that is needed. For most patients, a level below 25 μg/L (micrograms per liter) is normal, and above 25 is too high. A prolactin level above 250 μg/L most often indicates a prolactinoma. However, some drugs can cause levels to be that high. Your doctor will do other tests to look for the cause of excess prolactin. One cause is an underactive thyroid (hypothyroidism), so you may have a blood test to check your thyroid hormone levels. If the doctor thinks you may have a prolactinoma or other pituitary tumor, you likely will get an MRI (magnetic resonance imaging) scan of the brain and pituitary. If you are a woman of childbearing age, your doctor will rule out pregnancy as a cause of elevated prolactin.

Your medical history also is important in the diagnosis. Your doctor will ask if you have kidney or liver disease, which can cause high prolactin levels. Also, be prepared to tell your doctor which medicines you take. Some prescription medicines can raise prolactin levels. These include estrogen, opiate painkillers, metoclopramide to treat heartburn or gastroesophageal reflux, and antipsychotics for serious mental illness. Also, some medicines used to treat high blood pressure, depression, and ulcers can increase prolactin levels. What is the treatment? People with high prolactin levels who have few or no symptoms may not need treatment. For bothersome symptoms or other problems due to hyperprolactinemia, the type of treatment depends on the cause. Prolactinoma. The first step in treating this tumor is a prescription medicine that lowers prolactin production and decreases tumor size. The drug most often used is cabergoline, but bromocriptine is another option. Both medications work well for most people with prolactinomas.

After at least 2 years of treatment, if you no longer have the tumor and high prolactin levels, you may be able to slowly lower the dose or even stop taking the medicine. Ask your doctor if this is possible. Because the tumor may grow back once you stop treatment, you will need to return to the doctor for check-ups and tests. Your doctor will tell you how often you need follow-up. In some patients, the standard dose of medicine does not lower prolactin or shrink the tumor. Should this occur, you will get a higher dose of the medicine. If medicine is not effective or you have troublesome side effects, you may need surgery to remove the tumor. Rarely, neither medicine nor surgery works. In that case, radiation treatment may be an option to shrink the tumor. Radiation also may be used to shrink a prolactinoma if it is aggressive (growing and spreading quickly) or in the rare cases when it is malignant (cancerous). Medicine-induced hyperprolactinemia. If your physician thinks a medication you are taking has caused the excess prolactin, the doctor may tell you to stop taking that medicine for at least 3 days.

Do not stop taking your medicine unless your doctor instructs you to do so. After a time off the medicine, your doctor will order another blood test for prolactin, to see if the levels have returned to normal. If you cannot be off your medicine, your doctor will give you a similar drug that does not raise prolactin levels. When no good substitute drug is available, your doctor may give you cabergoline or bromocriptine to lower prolactin production. Or, if you have infertility, low sex drive, and low bone mass, you may receive treatment with estrogen (for women) or testosterone (for men). Hypothyroidism. An underactive thyroid most often needs treatment with synthetic (laboratory-made) thyroid hormone. Most often this treatment needs to be lifelong. Idiopathic hyperprolactinemia. Sometimes doctors cannot find a cause for hyperprolactinemia. This is called idiopathic. In some patients with idiopathic hyperprolactinemia, the high prolactin levels return to normal on their own. If this does not happen within a few months, symptomatic patients often receive treatment with cabergoline or bromocriptine.

What is the treatment of prolactinoma during pregnancy? Sometimes women who have a prolactinoma become pregnant during treatment. These women may need special treatment to ensure their baby’s good health. The guidelines for physicians recommend the following for pregnant women with this tumor: As soon as you know you are pregnant, it is usually best to stop taking cabergoline or bromocriptine. Do not stop taking the medicine unless your endocrinologist tells you to, however. Your doctor may want you to stay on treatment if you have a large prolactinoma that is harming, or could harm, your vision. If you must continue treatment, bromocriptine is the preferred drug for pregnant women. There is no need to get prolactin blood tests while you are pregnant. Prolactin levels are normally high during pregnancy. Unless a prolactinoma is growing or affecting your vision, you will not need routine MRIs during your pregnancy. These general recommendations apply to most pregnant women. Talk to your doctor about what is best for you and your baby.

Prolactin Follow @Medic8Health Prolactin Prolactin (PRL), or Luteotropic Hormone (LTH), is a protein consisting of peptide hormones, which regulate immune and endocrine functions within the human body. Production and secretion of Prolactin MRNA and DNA genetic structures govern how amino acids secrete peptide hormones into the blood stream for cell synthesis into the nucleus, which are then used for biological function. Prolactin is one of the peptide hormones released by the pituitary gland from the anterior, or adenohypophysis lactotrope cells, stimulating mammary glands. Prolactin is also secreted by cells in the breasts and uterine lining or endometrium (decidua). Prolactin function Prolactin and cytokine receptors impact immune system function through their interaction with Prolactin molecules. They are transmembrane protein receptors, which allow for intercellular communication and signal transduction for hormones, growth factors, cytokines, neurotransmitters and cell recognition. A receptor deficiency causes immunodeficiency within the body.

Therefore, Prolactin function is vital to regulate healthy cell growth and differentiation, blood clotting, blood cell formation (Haematopoiesis), blood vessel growth (angiogenesis), metabolism, endocrine process, brain and behavioural function. Pituitary Prolactin secretion The hypothalamus region of the brain regulates pituitary Prolactin secretion through the endocrine neurons. These neurosecretory and tuberoinfundibular (TIDA) neurons inhibit Prolactin secretion through dopamine receptors and function. Dopamine and other hormones, such as estrogen, progesterone and thyrotropin, send out signals for Prolactin production and secretion throughout the human body. This secretion is further regulated by other peptides, such as vasoactive intestinal and histidine isoleucine peptides. Prolactin function during pregnancy and childbirth Prolactin function involves lactation, which is the stimulation of the mammary glands for breast milk production. During pregnancy these mammary glands enlarge due to Prolactin concentrations.

The breast milk production, or lactogenesis, is contained through progesterone function during pregnancy (milk-ejection reflex) and only ejected for breast-feeding after birth, as the progesterone hormone levels reduce. Suckling by the infant stimulates further Prolactin release for lactation. The unborn baby is also affected by Prolactin, sometimes having milky secretion, or Witch's milk, from the nipples that soon subsides after birth. Prolactin and infant breathing Prolactin also plays a role in foetal lung development, allowing for surfactant molecules to diffuse and absorb at interfaces joining water and air, occurring at birth as the baby starts to breathe and use its lungs outside of the womb. After birth Prolactin levels in the baby's body deriving from the mother allow for immune tolerance and further immune system development. Prolactin and sexual gratification Recent research reveals that Prolactin may also play a role in sexual gratification after sexual intercourse. Dopamine is the hormone responsible for sexual drive and arousal. Prolactin levels repress dopamine's response for sexual arousal. Measures of Prolactin levels after intercourse may indicate degrees of sexual satisfaction.

Libido loss, impotence and ovulatory cycle suppression in females may be identified by high levels of Prolactin. Prolactin stimulates brain cell proliferation Precursor cells may be multi-potent stem cells or differentiate later into organs. Prolactin functions to stimulate precursor cell proliferation, such as for oligodendrocyte precursor cells (neuroglia brain cells) for central nervous system function. Role of Prolactin levels in diagnosis From the functions of Prolactin you can soon deduce how useful Prolactin levels are for the diagnosis of immunodeficiency, metabolic, endocrine, lactation, sexual, vascular and blood-related medical conditions. Prolactin levels are often used to check for: Normal sexual hormone function. Ovarian cycle function for female fertility or poly-cystic ovarian syndrome. Impotence, hypogonadism or erectile dysfunction in men. Lactation for breastfeeding and galactorrhea (non-pregnancy milk production). Dopamine function. Prolactinoma or tumour of the pituitary gland. Hypothyroidism. Medically-induced Prolactin deficiency, caused by anti-psychotic drugs. Visual disturbances and headaches.

Eating disorders, such as bulimia and anorexia. Different health conditions and diseases can be diagnosed based on high or low Prolactin levels. We all normally have small amounts of Prolactin levels in our blood stream. Prolactin Testing To test Prolactin levels for medical conditions a blood sample is drawn for testing, usually within about an hour of a person's waking to determine the type of seizure after occurrence. A doctor carries out Prolactin tests in a medical facility and no preparation is usually necessary. In certain cases Prolactin testing is combined with Magnetic Resonance Imaging (MRI) scans or other appropriate diagnostic tests. Prolactin stimulates lactogenesis or milk production after - HS - 400 View Full Document 20 Stimulation of the nipples and mammary gland, as occurs during nursing, leads to prolactin release. This effect appears to be due to a spinal reflex arc that causes release of prolactin-stimulating hormones from the hypothalamus. 2. Posterior Pituitary Hormones a. Oxytocin Stimulation of the paraventricular nuclei causes their neuronal cells to secrete the hormone oxytocin.

Oxytocin is released into the blood in the same manner that ADH is released—into the blood vessels of the posterior pituitary. Oxytocin (Greek: "quick birth") is a mammalian hormone that also acts as a neurotransmitter in the brain. In women, it is released mainly after distention of the cervix and vagina during labor, and after stimulation of the nipples, facilitating birth and breastfeeding, respectively. Oxytocin is released during orgasm in both sexes. In the brain, oxytocin is involved in social recognition and bonding, and might be involved in the formation of trust between people (i.e., the “cuddle hormone”). 21 Secretion of oxytocin from the neurosecretory nerve endings is regulated by the electrical activity of the oxytocin cells in paraventricular nucleus of the hypothalamus.

These cells generate action potentials that propagate down axons to the nerve endings in the pituitary; the endings contain large numbers of oxytocin-containing vesicles, which are released by exocytosis when the nerve terminals are depolarised Oxytocin receptors are expressed by the myoepithelial cells of the mammary gland, and in both the myometrium and endometrium of the uterus at the end of pregnancy.  Letdown reflex – in lactating (breastfeeding) mothers, oxytocin acts at the mammary glands, causing milk to be 'let down' into a collecting chamber, from where it can be extracted by sucking at the nipple. Sucking by the infant at the nipple is relayed by spinal nerves to the hypothalamus. The stimulation causes neurons that make oxytocin to fire action potentials in intermittent bursts; these bursts result in the secretion of pulses of oxytocin from the neurosecretory nerve terminals of the pituary gland. This preview has intentionally blurred sections. Sign up to view the full version. Prolactinoma Prolactinoma You can also order print versions from our online catalog. Additional Links Hours: 8:30 a.m.

to 5 p.m. eastern time, M-F Clinical Trials What is a prolactinoma? A prolactinoma is a benign noncancerous tumor of the pituitary gland that produces a hormone called prolactin. Prolactinomas are the most common type of pituitary tumor. Symptoms of prolactinoma are caused by hyperprolactinemia --- too much prolactin in the blood --- or by pressure of the tumor on surrounding tissues. Prolactin stimulates the breast to produce milk during pregnancy. After giving birth, a mother’s prolactin levels fall unless she breastfeeds her infant. Each time the baby nurses, prolactin levels rise to maintain milk production. [ Top ] What is the pituitary gland? The pituitary gland, sometimes called the master gland, plays a critical role in regulating growth and development, metabolism, and reproduction.

It produces prolactin and other key hormones including growth hormone, which regulates growth adrenocorticotropin (ACTH), which stimulates the adrenal glands to produce cortisol, a hormone important in metabolism and the body's response to stress thyrotropin, which signals the thyroid gland to produce thyroid hormone, also involved in metabolism and growth luteinizing hormone and follicle-stimulating hormone, which regulate ovulation and estrogen and progesterone production in women and sperm formation and testosterone production in men The pituitary gland sits in the middle of the head in a bony box called the sella turcica. The optic nerves sit directly above the pituitary gland. Enlargement of the gland can cause symptoms such as headaches or visual disturbances. Pituitary tumors may also impair production of one or more pituitary hormones, causing reduced pituitary function, also called hypopituitarism. The pituitary gland sits in the sella turcica. [ Top ] How common is prolactinoma? Although small benign pituitary tumors are fairly common in the general population, symptomatic prolactinomas are uncommon. Prolactinomas occur more often in women than men and rarely occur in children.

[ Top ] What are the symptoms of prolactinoma? In women, high levels of prolactin in the blood often cause infertility and changes in menstruation. In some women, periods may stop. In others, periods may become irregular or menstrual flow may change. Women who are not pregnant or nursing may begin producing breast milk. Some women may experience a loss of libido-interest in sex. Intercourse may become painful because of vaginal dryness. In men, the most common symptom of prolactinoma is erectile dysfunction. Because men have no reliable indicator such as changes in menstruation to signal a problem, many men delay going to the doctor until they have headaches or eye problems caused by the enlarged pituitary pressing against nearby optic nerves. They may not recognize a gradual loss of sexual function or libido. Only after treatment do some men realize they had a problem with sexual function. [ Top ] What causes prolactinoma? The cause of pituitary tumors remains largely unknown. Most pituitary tumors are sporadic, meaning they are not genetically passed from parents to their children. What else causes prolactin to rise? In some people, high blood levels of prolactin can be traced to causes other than prolactinoma.

Prescription drugs. Prolactin secretion in the pituitary is normally suppressed by the brain chemical dopamine. Drugs that block the effects of dopamine at the pituitary or deplete dopamine stores in the brain may cause the pituitary to secrete prolactin. These drugs include older antipsychotic medications such as trifluoperazine (Stelazine) and haloperidol (Haldol); the newer antipsychotic drugs risperidone (Risperdal) and molindone (Moban); metoclopramide (Reglan), used to treat gastroesophageal reflux and the nausea caused by certain cancer drugs; and less often, verapamil, alpha-methyldopa (Aldochlor, Aldoril), and reserpine (Serpalan, Serpasil), used to control high blood pressure. Some antidepressants may cause hyperprolactinemia, but further research is needed. Other pituitary tumors. Other tumors arising in or near the pituitary may block the flow of dopamine from the brain to the prolactin-secreting cells.

Such tumors include those that cause acromegaly, a condition caused by too much growth hormone, and Cushing's syndrome, caused by too much cortisol. Other pituitary tumors that do not result in excess hormone production may also block the flow of dopamine. Hypothyroidism. Increased prolactin levels are often seen in people with hypothyroidism, a condition in which the thyroid does not produce enough thyroid hormone. Doctors routinely test people with hyperprolactinemia for hypothyroidism. Chest involvement. Nipple stimulation also can cause a modest increase in the amount of prolactin in the blood. Similarly, chest wall injury or shingles involving the chest wall may also cause hyperprolactinemia. [ Top ] How is prolactinoma diagnosed? A doctor will test for prolactin blood levels in women with unexplained milk secretion, called galactorrhea, or with irregular menses or infertility and in men with impaired sexual function and, in rare cases, milk secretion. If prolactin levels are high, a doctor will test thyroid function and ask first about other conditions and medications known to raise prolactin secretion.

The doctor may also request magnetic resonance imaging (MRI), which is the most sensitive test for detecting pituitary tumors and determining their size. MRI scans may be repeated periodically to assess tumor progression and the effects of therapy. Computerized tomography (CT) scan also gives an image of the pituitary but is less precise than the MRI. The doctor will also look for damage to surrounding tissues and perform tests to assess whether production of other pituitary hormones is normal. Depending on the size of the tumor, the doctor may request an eye exam with measurement of visual fields. [ Top ] How is prolactinoma treated? The goals of treatment are to return prolactin secretion to normal, reduce tumor size, correct any visual abnormalities, and restore normal pituitary function. In the case of large tumors, only partial achievement of these goals may be possible. Medical Treatment Because dopamine is the chemical that normally inhibits prolactin secretion, doctors may treat prolactinoma with the dopamine agonists bromocriptine (Parlodel) or cabergoline (Dostinex). Agonists are drugs that act like a naturally occurring substance.

These drugs shrink the tumor and return prolactin levels to normal in approximately 80 percent of patients. Both drugs have been approved by the U.S. Food and Drug Administration for the treatment of hyperprolactinemia. Bromocriptine is the only dopamine agonist approved for the treatment of infertility. This drug has been in use longer than cabergoline and has a well-established safety record. Nausea and dizziness are possible side effects of bromocriptine. To avoid these side effects, bromocriptine treatment must be started slowly. A typical starting dose is one-quarter to one-half of a 2.5 milligram (mg) tablet taken at bedtime with a snack. The dose is gradually increased every 3 to 7 days as needed and taken in divided doses with meals or at bedtime with a snack. Most people are successfully treated with 7.5 mg a day or less, although some people need 15 mg or more each day. Because bromocriptine is short acting, it should be taken either twice or three times daily. Bromocriptine treatment should not be stopped without consulting a qualified endocrinologist-a doctor specializing in disorders of the hormone-producing glands.

Prolactin levels rise again in most people when the drug is discontinued. In some, however, prolactin levels remain normal, so the doctor may suggest reducing or discontinuing treatment every 2 years on a trial basis. Cabergoline is a newer drug that may be more effective than bromocriptine in normalizing prolactin levels and shrinking tumor size. Cabergoline also has less frequent and less severe side effects. Cabergoline is more expensive than bromocriptine and, being newer on the market, its long-term safety record is less well defined. As with bromocriptine therapy, nausea and dizziness are possible side effects but may be avoided if treatment is started slowly. The usual starting dose is .25 mg twice a week. The dose may be increased every 4 weeks as needed, up to 1 mg two times a week. Cabergoline should not be stopped without consulting a qualified endocrinologist. Recent studies suggest prolactin levels are more likely to remain normal after discontinuing long-term cabergoline therapy than after discontinuing bromocriptine. More research is needed to confirm these findings.

In people taking cabergoline or bromocriptine to treat Parkinson's disease at doses more than 10 times higher than those used for prolactinomas, heart valve damage has been reported. Rare cases of valve damage have been reported in people taking low doses of cabergoline to treat hyperprolactinemia. Before starting these medications, the doctor will order an echocardiogram. An echocardiogram is a sonogram of the heart that checks the heart valves and heart function. Because limited information exists about the risks of long-term, low-dose cabergoline use, doctors generally prescribe the lowest effective dose and periodically reassess the need for continuing therapy. People taking cabergoline who develop symptoms of shortness of breath or swelling of the feet should promptly notify their physician because these may be signs of heart valve damage. Surgery Surgery to remove all or part of the tumor should only be considered if medical therapy cannot be tolerated or if it fails to reduce prolactin levels, restore normal reproduction and pituitary function, and reduce tumor size. If medical therapy is only partially successful, it should be continued, possibly combined with surgery or radiation. Most often, the tumor is removed through the nasal cavity.

Rarely, if the tumor is large or has spread to nearby brain tissue, the surgeon will access the tumor through an opening in the skull. The results of surgery depend a great deal on tumor size and prolactin levels as well as the skill and experience of the neurosurgeon. The higher the prolactin level before surgery, the lower the chance of normalizing serum prolactin. Serum is the portion of the blood used in measuring prolactin levels. In the best medical centers, surgery corrects prolactin levels in about 80 percent of patients with small tumors and a serum prolactin less than 200 nanograms per milliliter (ng/ml). A surgical cure for large tumors is lower, at 30 to 40 percent. Even in patients with large tumors that cannot be completely removed, drug therapy may be able to return serum prolactin to the normal range-20 ng/ml or less-after surgery. Depending on the size of the tumor and how much of it is removed, studies show that 20 to 50 percent will recur, usually within 5 years.

Because the results of surgery are so dependent on the skill and knowledge of the neurosurgeon, a patient should ask the surgeon about the number of operations he or she has performed to remove pituitary tumors and for success and complication rates in comparison to major medical centers. The best results come from surgeons who have performed hundreds or even thousands of such operations. To find a surgeon, contact The Pituitary Society (see For More Information). Radiation Rarely, radiation therapy is used if medical therapy and surgery fail to reduce prolactin levels. Depending on the size and location of the tumor, radiation is delivered in low doses over the course of 5 to 6 weeks or in a single high dose. Radiation therapy is effective about 30 percent of the time. [ Top ] How does prolactinoma affect pregnancy? If a woman has a small prolactinoma, she can usually conceive and have a normal pregnancy after effective medical therapy. If she had a successful pregnancy before, the chance of her having more successful pregnancies is high. A woman with prolactinoma should discuss her plans to conceive with her physician so she can be carefully evaluated prior to becoming pregnant.

This evaluation will include an MRI scan to assess the size of the tumor and an eye examination with measurement of visual fields. As soon as a woman is pregnant, her doctor will usually advise her to stop taking bromocriptine or cabergoline. Although these drugs are safe for the fetus in early pregnancy, their safety throughout an entire pregnancy has not been established. Many doctors prefer to use bromocriptine in patients who plan to become pregnant because it has a longer record of safety in early pregnancy than cabergoline. The pituitary enlarges and prolactin production increases during pregnancy in women without pituitary disorders. Women with prolactin-secreting tumors may experience further pituitary enlargement and must be closely monitored during pregnancy. Less than 3 percent of pregnant women with small prolactinomas have symptoms of tumor growth such as headaches or vision problems. In women with large prolactinomas, the risk of symptomatic tumor growth is greater, and may be as high as 30 percent. Most endocrinologists see patients every 2 months throughout the pregnancy.

A woman should consult her endocrinologist promptly if she develops symptoms of tumor growth-particularly headaches, vision changes, nausea, vomiting, excessive thirst or urination, or extreme lethargy. Bromocriptine or, less often, cabergoline treatment may be reinitiated and additional treatment may be required if the woman develops symptoms during pregnancy. [ Top ] How do oral contraceptives and hormone replacement therapy affect prolactinoma? Oral contraceptives are not thought to contribute to the development of prolactinomas, although some studies have found increased prolactin levels in women taking these medications. Because oral contraceptives may produce regular menstrual bleeding in women who would otherwise have irregular menses due to hyperprolactinemia, prolactinoma may not be diagnosed until women stop oral contraceptives and find their menses are absent or irregular. Women with prolactinoma treated with bromocriptine or cabergoline may safely take oral contraceptives. Similarly, postmenopausal women treated with medical therapy or surgery for prolactinoma may be candidates for estrogen replacement therapy. [ Top ] Is osteoporosis a risk in women with high prolactin levels?

Women whose ovaries produce inadequate estrogen are at increased risk for osteoporosis. Hyperprolactinemia can reduce estrogen production. Although estrogen production may be restored after treatment for hyperprolactinemia, even a year or 2 without estrogen can compromise bone strength. Women should protect themselves from osteoporosis by increasing exercise and calcium intake through diet or supplements and by not smoking. Women treated for hyperprolactinemia may want to have periodic bone density measurements and discuss estrogen replacement therapy or other bone-strengthening medications with their doctor. [ Top ] Clinical Trials The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions. What are clinical trials, and are they right for you? Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you . What clinical trials are open?

Clinical trials that are currently open and are recruiting can be viewed at . This information may contain content about medications and, when taken as prescribed, the conditions they treat. When prepared, this content included the most current information available. For updates or for questions about any medications, contact the U.S. Food and Drug Administration toll-free at 1-888-INFO-FDA (1-888-463-6332) or visit . Consult your health care provider for more information. [ Top ] This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings through its clearinghouses and education programs to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts. The NIDDK would like to thank: Michael O. Thorner, M.B., D.Sc., University of Virginia Health System; Shlomo Melmed, M.D., Cedars-Sinai Health System This information is not copyrighted.

The NIDDK encourages people to share this content freely. HON Mother & Child Glossary, Hormonal Changes During Pregnancy Hormonal Changes During Pregnancy Hormones are chemically diverse substances (e.g. steroids; peptides), which are released into the bloodstream in response to some stimulus, and activate cells, depending on the hormone in question. The main hormones involved in pregnancy and their functions are listed below. Human Chorionic Gonadotropin (hCG) stimulates the production of oestrogen and progesterone within the ovary. It is released very early in pregnancy and isn't present at any other time. This is the hormone which pregnancy tests look for. Production of this hormone diminishes once the placenta is mature enough to take over oestrogen and progesterone production. Oestrogen This hormone causes the breast tenderness and enlargement which are typical of early pregnancy. It is produced throughout pregnancy, and helps to regulate levels of progesterone and prepare the womb for the baby and the breasts for feeding. Progesterone Prevents the womb from spontaneously aborting the foetus by building up the lining so that it can support the placenta , and by preventing the natural movement and contractions of the womb.

This is the hormone which is responsible for the loss of interest in sex during pregnancy. Prolactin Prolactin is produced by the pituitary gland. It is responsible for the increase in cells which produce milk within the breasts. Progesterone and oestrogen actually prevent milk from being produced. Immediately after birth, the levels of these hormones drop dramatically, allowing prolactin to stimulate the initial production of milk. Suckling also controls milk production. Prolactin also helps prevent a nursing mother from falling pregnant, but cannot be relied on as the only form of contraception. Relaxin This is found early in pregnancy and is responsible for helping limit the activity of the womb and soften the cervix in preparation for delivery. Oxytocin Oxytocin seems to be involved in reproductive behaviour in both men and women, and apparently triggers "caring" behaviour. It is also the hormone which allows contractions of the womb during pregnancy and labour . Contractions felt during breast feeding are also due to oxytocin. Also used to induce labour . Prostaglandins These are tissue hormones and seem to play a role in getting labour started.

Synthetic prostaglandins are used to induce labour in a pregnancy which has gone past its 40th week The information in this page is presented in summarised form and has been taken from the following source(s): 1. iafrica.com, Women's Health Section : Other HON resources List of Prolactin inhibitors - Drugs.com Prolactin inhibitors What are Prolactin inhibitors Prolactin inhibitors are agents that inhibit the production of prolactin, a hormone that stimulates milk production after childbirth. In both sexes, excessive secretion of prolactin (hyperprolactinemia) can give rise to abnormal production of milk (galactorrhea). Prolactin inhibitors are dopamine agonists, which effectively treat hyperprolactinemia. A drug may be classified by the chemical type of the active ingredient or by the way it is used to treat a particular condition. Each drug can be classified into one or more drug classes. Prolactin inhibitors are agents that inhibit the production of prolactin, a hormone that stimulates milk production after childbirth. In both sexes, excessive secretion of prolactin (hyperprolactinemia) can give rise to abnormal production of milk (galactorrhea).

Prolactin inhibitors are dopamine agonists, which effectively treat hyperprolactinemia. List of Prolactin inhibitors: Prolactin Excess * Prolactin: A Milk Producing Hormone * Causes of Prolactin Excess * Treatment of Prolactin Excess Prolactin Excess PROLACTIN: A MILK-PRODUCING HORMONE Prolactin is a hormone secreted by the pituitary gland which is located at the base of the brain. It circulates in low levels in the bloodstream of non pregnant women. During pregnancy, prolactin levels increase approximately ten-fold and stimulate milk formation. Hyperprolactinemia is a condition in which excess prolactin circulates in the bloodstream of non pregnant women. Hyperprolactinemia can produce a variety of reproductive dysfunctions including inadequate progesterone production during the luteal phase after ovulation, irregular ovulation and menstruation, absence of menstruation, and galactorrhea (breast milk production by a woman who is not nursing). Prolactin levels should be measured in women who experience these conditions.

In men, hyperprolactinemia may be associated with impotence and can affect fertility. Prolactin secretion may increase mildly with sleep, stress, coitus, exercise, nipple stimulation, ingestion of certain foods, and pregnancy. If a woman’s prolactin level is elevated the first time it is tested, a second sample should be checked when she is fasting and non-stressed. Confirmed elevations of prolactin need to be evaluated. Causes of Prolactin Excess A medical history, physical examination, and imaging studies such as magnetic resonance imaging (MRI) or computerized tomography (CT) of the pituitary will identify most causes of prolactin excess. Surgical scars on the chest wall and other chest wall irritations (shingles for example) can trigger excess prolactin secretion. A variety of medications, most notably certain tranquilizers, high blood pressure medications, and antinausea drugs can lead to excess prolactin secretion. Oral contraceptives and “recreational drugs” such as marijuana may also result in mild prolactin excess.

Primary hypothyroidism, a condition in which an inadequate amount of thyroid hormone is produced, is the most common medical condition that can cause hyperprolactinemia. Treating the hypothyroidism with thyroid hormone can correct the hyperprolactinemia. Rarely, other medical conditions, such as chronic kidney failure, may be responsible for hyperprolactinemia. Lastly, tumors of the pituitary gland and lesions that compress the hypothalamic-pituitary stalk can cause hyperprolactinemia. These tumors can usually be identified by MRI or CT scans in 30-40 percent of women with hyperprolactinemia. In approximately 30 percent of cases, the hyperprolactinemia is unexplained. Treatment of Prolactin Excess Bromocriptine (Parlodel®) is the main drug used to treat prolactin excess. It works by suppressing prolactin production. The starting dosage is usually 1.25 to 2.5 mg nightly, with the dosage slowly increased until prolactin levels return to the normal range. Larger doses are frequently required to suppress larger pituitary tumors.

Ovulation and menstruation generally return within six weeks of normalizing prolactin levels. Galactorrhea takes more time and is less certain to resolve. Treatment is generally continued until pregnancy occurs, at which time bromocriptine is usually discontinued. In the absence of pregnancy, therapy is usually continued for one to two years or longer because of the high rate of symptom recurrence once the medication is discontinued. The effectiveness of bromocriptine in controlling hyperprolactinemia due to pituitary tumors has greatly reduced the need for surgery and radiation to treat these conditions. The side effects associated with bromocriptine usually resolve within the first month of use. Lightheadedness, nausea, and headache are the most common initial side effects. Other side effects include nasal congestion, dizziness, constipation, abdominal cramps, fatigue, vomiting, and rarely neurologic symptoms such as hallucinations. Side effects are minimized by slowly increasing the dosage to build tolerance. Bromocriptine may also be administered vaginally at bedtime. Hyperprolactinemia is a common clinical problem.

It is found in up to one-third of patients with absence of menstruation and in up to 90 percent of women with galactorrhea. Observation and expectant management is appropriate for some of these women, and medical management is highly successful in others. Content Provided By: AMERICAN SOCIETY FOR REPRODUCTIVE MEDICINE Formerly The American Fertility Society 1209 MontgomeryHighway • Birmingham, Alabama 35216-2809 • T E L (205) 978-5000 • FAX (205) 978-5005 • E-MAIL asrm@asrm.org • URL Childbirth: Challenges After Childbirth By Sylvia Brown WebMD Live Events Transcript All the planning for that big day when baby arrives makes it easy to forget about the challenging days and months after delivery. Author Sylvia Brown addresses these potential physical, sexual , and emotional pitfalls in The Post-Pregnancy Handbook. She joined us on Oct. 23, 2003 to talk about what nobody told you. The opinions expressed herein are the guest's alone and have not been reviewed by a WebMD physician.

If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only. Moderator: Welcome to WebMD University: "Bootie Camp: A 4-Week Guide to Baby's First Year." Sylvia Brown, author of The Post Pregnancy Handbook. Today she will answer your questions about the first year after giving birth. You may send in your questions at any time during the event. Support for this WebMD University course provided by Blue Cross Blue Shield of Massachusetts. Welcome to WebMD University, Sylvia. What was the biggest surprise you experienced after giving birth? Brown: My biggest surprise was physical pain. I thought that after childbirth I would be marching off into the sunset with my new baby. But the combination of a big episiotomy , major forceps, and hemorrhoids was almost unbearable. Nobody gave me any ideas for what I could do to ease the pain, and I discovered that running water over the wounds was very helpful. I ended up taking 14 showers on my first day after childbirth.

Later after doing research for the book, I discovered there are all kinds of things you can do to ease pain in the genital area, some with heat and some with cold, and different women find heat or cold to be more helpful, depending on what their problem is. For example, pouring cold water or ice water over the perineum or filling a latex glove or an examination glove with water and asking the nurses to put it in the freezer are two good ideas. There are also special sanitary gel pads available on the market, which can be kept in the freezer. One is called the Femme Pad, which feels wonderful. Other women prefer heat to soothe the wound and some hospitals will provide a heat lamp. Also, it's important to keep the area very clean and to pour water over it and clean it gently every time you go to the bathroom. Moderator: Giving birth triggers hormonal changes -- how do those affect a new mom? Brown: The key to understanding the effect of hormonal changes is that hormonal levels drop precipitously the minute the baby is born and the placenta is expelled, because the placenta was the hormone production factory in the body.

So the reason different women react differently after childbirth really depends on how their body will cope with the change or the drop in hormonal levels, not with the actual amount of hormones in their body. The best-known effect of this drop in hormones is the effect on your mood, but there are many other hormones that were present during pregnancy. For example, relaxin is the hormone that increases the size and elasticity of muscles in the body and helps you to deliver your baby. That hormone takes about five months to leave your body, so for five months you're much more prone to sprains and hurting yourself than you would be normally. Some hormones increase your appetite. Prolactin, the hormone that causes milk production is an appetite stimulant. So while the absence of some hormones have one series of effects, the continued presence of others almost keep you in a pregnant state. Member question: I feel like I'm on the verge of crying so often. I wanted my baby and I love her, but I feel so fragile and tired. What is going on with me? Brown: Eighty percent of new mothers feel exactly like you do in the first two weeks after childbirth.

This is known as baby blues and is due to the drop in hormones, and simply to the newness of the situation. It will go away. However, if you still feel on the verge of tears for several months after childbirth, you may be experiencing postnatal depression . The challenge is to determine whether you're just overly tired, possibly anemic, or lacking in some vitamins, or whether you are actually experiencing depression. If this is your case, you need to talk to a professional to determine whether you could use some medication or whether you just need to reorganize your life and take some vitamin supplements to get over the fatigue that is causing your tears. Member question: How long after giving birth do I need to keep taking prenatal vitamins? Brown: Please keep taking your prenatal vitamins for at least two months after giving birth. I'm delighted that you are doing so, because many women don't realize how depleted their vitamin stores are and how essential it is to keep taking prenatal vitamins after birth. Member question: Do you know if anything works to reduce the visibility of C-section scarring? Brown: First of all, it takes time. You probably will need about a year for your scar to disappear. It may itch for up to five months after your delivery.

It may suddenly become red before shrinking to its permanent shape about eight months after the surgery. In your first few weeks at home, you should be particularly careful about hygiene and caring for your scar. You can rub vitamin E oil or almond oil on it, or apply a poultice of green clay, which is available in health food stores, to the scar once it's completely healed. Also, do not expose the scar to direct sun for a year. Member question: This may seem petty vain, but I really want to get rid of these stretch marks . What works? Brown: Stretch marks will gradually narrow to fine white lines, but it will take time. If your stretch marks are still highly visible six months after delivery, you might consider dermabrasion or vitamin A acid cream, or even plastic surgery in extreme cases. All of these should be done under the supervision of a doctor. Please do not try any unlicensed techniques, as they probably will do you more harm than good. Member question: Nobody told me that after the initial excitement everyone would go back to normal except me. The baby is four weeks old and sleeps much of the time, except she wakes up so often that I am not getting the sleep I need.

My mom says to be patient, that babies really get their cute personalities when they are little older. I don't know what I was thinking, but I feel tired and isolated. Brown: Most women do not plan sufficiently ahead. Having a baby is not marching into the sunset. Before you go into the hospital, organize a network of friends and family to help you with housework, with babysitting, and to ensure that you will have some time for yourself, some time to get out of the house, and time to nap. Ask friends to come cook you dinner and do the dishes. Ask friends to hire a housekeeper or a baby nurse for a few hours, rather than give you clothes for the baby. Team up with other new mothers that live nearby and take turns watching the two babies so one of the mothers can have some time off. Planning and prevention are the best cures for fatigue. Recreation is also very important. And make sleep a priority. Nothing is more important than sleep, so whenever you can, nap. Member question: My friends are all at my old job. None of them are parents yet. I feel a bit disconnected from them. Any advise? Brown: You will soon begin to make new friends with other new moms.

There probably are new mother groups in your community that you can attend, or other ways for you to meet these new moms. You will find endless topics to discuss together, because you now have so much in common. Having a baby is an intricate into a new life and a great opportunity to expand your network of friends. The hospital or birthing center may have addresses of parenting groups. If you look in some of the free community parenting newspapers there might be some names and addresses. Also, churches provide new parent groups. Member question: I was planning to return to work but now I can't stand the thought of being away from my child. Should I tell my boss now or wait until my leave is almost over? Brown: Much depends on your company's policy, but you need to decide what the costs and benefits are of telling your boss now as opposed to waiting. Some things to think about: How much advance notice do you need to give them? Have you been replaced by someone temporary? Were you in the middle of a major project that needs to be finished? Are there things you could be doing from home? Will your boss be upset and give you a bad reference?

Member question: How did you handle all the relatives and friends that wanted to come right over and celebrate the new baby? We want to have time to bond and cocoon a little before exposing the baby to all those people (and their germs). How do we announce this diplomatically? Brown: You are so right. Use your husband/partner as the watchdog and bodyguard. Men usually love this role. Why not plan a celebration in a few weeks when you feel up to it, or institute visiting hours, a time maybe in the afternoon twice a week when people are welcome to come over. But make sure they know these hours are limited. Get the word out that you don't want people to drop by unannounced. Screen your phone calls using your answering machine. Moderator: Some people post pictures on the Internet with a guest book so that virtual visits are possible. This allows everyone to coo over the baby in a safe way until you are ready to have real guests. Member question: I was surprised by the gurgling, wheezy sounds our baby made the first few weeks. We always thought she was choking! Did you worry a lot about your baby's breathing?

Brown: Obviously if you have any concerns, consult a health professional, but you will find, after a few weeks, that you know your baby's sounds and your mother's instinct will tell you when something's not normal. Remember, it takes time to get to know this little person, but within just a few weeks, you will feel much more comfortable and much less apprehensive. Member question: Can you talk about diet after childbirth? I want to nurse but I also want to get back to proper weight. Brown: Right after childbirth your body needs to recover. Your iron and vitamin and mineral stores have been depleted. Seventy percent of new mothers are anemic. Therefore, you shouldn't think of dieting for two to three months after childbirth. Immediately after the baby is born, you will lose about 11 pounds. You will then lose 9 to 11 more pounds over the next few weeks in fluids, a shrinking uterus, etc. Then your goal should be to lose no more than one to two pounds a month for the first six months. Losing more than 4 1/2 pounds a month is unsafe.

Different women lose different amounts of weight after childbirth: Skinny moms who gain 30 to 35 pounds lose most of their pregnancy weight in the first three months. Borderline overweight, older moms, third- or fourth-time moms who gain between 35 and 75 pounds, lose most of their weight between the third and sixth month. It is especially important for these moms not to remain more than a few pounds over their pre-pregnancy weight. Overweight moms will lose most of their excess weight 6 to 9 months after childbirth. So weight loss takes time. The key to remember is to eat right. You need to keep your energy levels up and you need to keep your serotonin levels up (these are the neurotransmitters that determine your mood) with a diet rich in complex carbs. This is not the time to go on a protein diet. You should be eating about 2000 calories, 50 to 60% of which should be complex carbs, 25 to 30% of which should be fat, and 20% of which should be protein.

If you are breastfeeding , you are burning 750 extra calories, so you should be eating 2,500 calories a day and you need 12 to 15 grams of extra protein. This means two glasses of milk or two extra eggs. Breastfeeding is not a weight loss guarantee, because for the first four months, prolactin, the hormone that stimulates milk production, also stimulates appetite and breastfeeding women tend to retain fluid. The good news is that after four to six months, prolactin levels drop, but a breastfeeding mother's metabolism retains high. This means her body will burn fat and this is the one time in a woman's life where she will burn the fat in her thighs. So stick with breastfeeding for more than four months and it will be beneficial to your weight loss. The bottom line is you need to eat right with as many fresh foods as possible, watching your calorie intake, but do not diet. Member question: How soon after giving birth does your period start again? And do you go back to having the same kind of cycle as before pregnancy? Friends have told me that after childbirth, cramps are lessened. Brown: Each woman is different.

Some women find that they no longer have cramps; others claim there is no change. If you are not breastfeeding, you generally will start menstruating six to eight weeks postpartum. If you are breastfeeding, you may not menstruate until you wean the baby. Other women get their period back but continue to breastfeed. Your first period after childbirth is often much heaver and lasts longer than usual. Breastfeeding is not a form of contraception. It is the sensation of the baby sucking that sends a message to the brain to suppress the hormone that stimulates ovulation. This means that the baby needs to be almost continuously sucking for the brain to block ovulation. In Western societies, most women do not go around with the baby at their breast all the time. In some cases if the baby sucks its thumb or a pacifier, this may be enough to diminish the intensity of his sucking. Member question: How long after giving birth should you wait before resuming your love life? Brown: Generally, doctors will give you a green light about six weeks after childbirth, but remember your genital organs and your reproductive system are not fully healed until two months after childbirth.

A lot depends on your scars , how sore you are, how tired you are, whether you're having problems with lubrication, and whether you might still be bleeding. Many women feel that the baby satisfies their need for intimate contact for quite a while after childbirth. Others find their sex drive returns fairly quickly. The most important thing is not to rush it. This means having a heart-to-heart discussion with him before the baby is born, warning him you may not be feeling like having sex for quite a while after childbirth, and keeping him informed about your feelings once the baby is born. Resuming sex after childbirth is above all, a question of patience. Once you are ready, you will need extra lubrication and you will need to go at it very gently and slowly, because it's almost certain to be a little painful the first few times. If you find the pain unbearable, please, please consult a professional health practitioner. Member question: I know a couple who had some intimacy problems after their baby was born because he suddenly looked at her as a mommy, not as someone you have sex with. Is this a common reaction from men? Brown: This is a very common reaction.

The most important thing you can do is talk to your husband/partner before the baby's birth about how things are going to change. Men often complain about being caught unaware and not being warned about how the relationship will change. Make sure that your husband/partner understands that while you are a mother, you are also a woman and he needs to recognize that you are capable of being both, and that it is important for your self-esteem that you are seen as both. This is where good communication really pays off. Member question: I seem to remember certain exercises we were told to do after giving birth to strengthen the pelvic floor. Is that still a concern? Brown: It is absolutely vital that you tone your pelvic floor after childbirth, even if you had a C-section. During pregnancy the weight of your uterus increased 20 to 30 times. The ligaments holding up your organs were weaker. Childbirth stretches and distends your pelvic floor, which loses 50% of its tone. The sphincters don't work as well and your organs are less well suspended. You prepared for nine months to open up; now you need to close up. This is also vital for the quality of your sex.

There are a number of gentle exercises you can do to tone your sphincters, but you must do them during the first six weeks after childbirth and you must not start exercising until your pelvic floor is toned and fit again. If not, you risk incontinence later in life or organ prolapse. Forty to 50% of women experience urinary incontinence at some point in their lives. One in 4 experiences stress incontinence after childbirth. That's leaking urine after a cough or a sneeze or a laugh. I recommend waiting six to 10 weeks before starting exercise. Walking and swimming are the best exercises. You can start toning about 15 minutes at a time two months after childbirth, building up by five minutes a week. Bicycling, tennis, and low-impact aerobics should wait until four to five months after childbirth when the hormone relaxin has completely left your body, when your pelvic floor is strong again, when you are less fatigued, and when you are ready to take on the demands of an exercise program. Moderator: Unfortunately, we are out of time. Thanks for joining us, members, and thanks to Sylvia Brown for sharing her expertise and experience with us.

For more information, please read The Post Pregnancy Handbook, by Sylvia Brown and The Mother of All Baby Books by our "Baby Bootie Camp" University course instructor, Ann Douglas.

Question: The hormone prolactin stimulates the production of what after childbirth?
Answer: Milk